Deandre Medlock, PTA

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

53465 Issued in CA

Practice address

4300 Golden Center Dr Ste B
Placerville, CA 95667-6278

Phone

(530) 344-2045

Fax

(530) 642-0794

NPI assigned

Jun 11, 2026

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ron L Kopitzke PT, DPT Ocs

  • Specialist
  • Placerville, CA
  • NPI 1821008236
  NPD (past)
• Sierra Orthopaedic & Athletic Rehabilitation Physical Therapyinc

  • Physical Therapist
  • Placerville, CA
  • NPI 1225721442
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1781136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1306770490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4304 DEERGRASS ST",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "957428278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 GOLDEN CENTER DR STE B",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956676278",
            "telephone_number": "530-344-2045",
            "fax_number": "530-642-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLOCK",
        "first_name": "DEANDRE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-06-11",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "53465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Leslie McIntyre, RPH
• Margaret McKay
• Anne Catherine McNelis, RN
• Steve McNitt, LCSW
• Pamela Kay Means
• Danielle Meiggs
• Monica Mejia, B.A.
• Amber Mendenhall
• Charlene Meneely
• Menm, LLC

• Physical Therapist in Placerville, CA
• Providers in Placerville, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.